How Does Bipolar Disorder Present in Children and Adolescents? - Diagnosing Bipolar Disorder in Children and Teens

At the Doctor's Office

The mood and behavior problems prompting an office visit may look different or may not be seen during the actual appointment. Clinicians may need to talk with parents, schools, and other important caregivers to evaluate a child's functioning in these areas.

Clinicians may have to deal with some of the following challenges in diagnosing and treating a child or adolescent with bipolar disorder.

• Symptoms vary over time and their appearance changes as the child grows. A clinician may need to see a child over a period time to determine the appropriate diagnosis.
• Symptoms caused by other medical conditions and by certain medications can be confused with bipolar disorder. These conditions include hyperthyroidism, seizure disorders, multiple sclerosis, strokes, tumors, and infections. Prescribed medications (steroids, antidepressants, stimulants, and some treatments for acne) and non-prescribed drugs (cocaine, amphetamine) can cause severe mood changes. Relevant laboratory tests and physical examinations may be helpful when bipolar disorder is considered.

  advertisement

• Bipolar disorder often first appears as depression in adolescents. Sudden onset depression, accompanied by sluggishness and excessive sleeping has been the most common "depression profile" seen in young people who later develop manic symptoms. A family history of bipolar disorder also increases the possibility that a depressed child may go on to develop bipolar disorder. In children with bipolar disorder, antidepressants may improve depressive symptoms but can sometimes unmask or worsen manic symptoms. Careful monitoring is recommended for any child receiving antidepressants.
• Bipolar disorder is often misdiagnosed as ADHD because some symptoms overlap, and many children with early onset of bipolar disorder also have ADHD. Stimulants (such as Ritalin, Concerta, Adderall) can aggravate mood instability, so it is important to stabilize the child's mood before beginning treatment for ADHD.
• Children may be unaware, or unwilling to admit, that their behavior may indicate symptoms of a disorder
• Especially during periods of relative wellness, older children and adolescents may refuse to take their medication. They may prefer to think of themselves as totally well.
• Medication side effects, such as significant weight gain or acne, may create further difficulties for the child
• Families may need to be coached about what they can reasonably expect from their child. Children who suffer from bipolar disorder will benefit if their family understands that therapy and medicines may reduce, but do not cure, symptoms.
• Families and children should be prepared to expect periodic relapses as part of the normal course of the illness. It can be very discouraging to see the return of prior symptoms that were presumed to be "conquered," but less so if it is understood that these temporary relapses are to be expected. Symptoms tend to return during times of high stress: the start of a new school year, holidays, physical illness, moving to a new community, and so on. These relapses may indicate the need to make an adjustment to medications or they may have a seasonal pattern

Sources:

• American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 4th Edition. Washington, DC: American Psychiatric Association, 1994
• Dulcan, MK and Martini, DR. Concise Guide to Child and Adolescent Psychiatry, 2nd Edition. Washington, DC: American Psychiatric Association, 1999
• Lewis, Melvin, ed. Child and Adolescent Psychiatry: A Comprehensive Textbook, 3rd Edition. Philadelphia: Lippincott Williams and Wilkins, 2002

next: Parenting A Bipolar Child - Help Your Child Lead A Rewarding Life